위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.

냉동 제대혈 세포의 체외 증폭

김삼용,김철희,배광봉,김현수,박상준,김종숙,윤환중,조덕연 충남대학교 암연구소 1998 癌共同硏究所 硏究誌 Vol.2 No.1

Background : Cord blood(CB), which has no HLA restriction, is an alternative to bone marrow for hematopoietic stem cell transplantation. The use of cord blood, however, is limited by the number of progenitor/stem cells necessary to reconstitute the older child or adult. Therefore, ex vivo expansion of CB could have tremendous impact on diverse clinical settings. We studied the ex vivo expansion of isolated population of CD34_(+) cells from cryopreserved CB cells. Methods : CD34 cells were isolated from cryopreserved CB mononuclear cells. Purified cells were cultured with various combinations of hematopoietic growth factors including erythropoietin(EPO), stem cell factor(SCF), granulocyte-colony-stimulating factor(G-CSF), gra-nulocyte, macrophage-colony-stimulating factor(GM-CSF), interleukin-1β(IL-1β), 1L-3, and IL-6. After 7, 10 or 14 days of culture, the fold increases of colony-forming unit- granu-locyte, macrophage(CFU-GM), burst-forming unit-erythroid(BFU-E), colony-forming unit-mix (CFU-Mix), and high proliferative potential colony-forming cell(HPP-CFC) were evaluated. Results : Ten-day culture with the combination of EPO, SCF, G-CSF, IL-1β, and IL-3 resulted in a median of 60-fold increase of CFU-GM, which was greater than those with the combinations of less than 5 growth factors. The addition of IL-6 or GM-CSF to this combination did not enhance CFU-GM expansion. Ten-day culture was significantly superior to 7-day culture for CFU-GM expansion. Prolongation of culture to 14 days, however, revealed decreased expansion of CFU-GM compared to 10 days. BFU-E and CFU-Mix were expanded to 2~5 folds in 7-day culture with the combination of EPO, SCF, and G-CSF. Further expansion was not achieved in 10-day culture and colonies disappeared in 14-day culture. HPP-CFC was expanded to a median of 7.5 folds in 7-day culture with the combination of EPO, SCF, G-CSF, IL-1β, IL-3, and IL-6. Neither 10-day or 14 day-culture enhanced expansion of HPP-CFU. Conclusion : Cryopreserved cord blood cells maintain ex vivo expansion potential. In our system, 10-day culture with the combination consisting of EPO, SCF, G-CSF, IL-1β, and IL-3 seems to be adequate for hematopoietic progenitor/stem cell expansion from cryopreserved cord blood cells.

펄프지료의 pH가 고해에 미치는 효과

김창락,문상환,김재옥,김철환,박종열 경상대학교 농업생명과학연구원 2003 농업생명과학연구 Vol.37 No.4

펄프 섬유를 이용해서 종이를 제조하기 위해서는 반드시 섬유를 물에 현탁시키는 해리와 섬유 벽에 물리적 변화를 부여하는 고해의 과정을 거쳐야 하고, 이 과정에서 섬유는 팽윤 과정을 겪게 된다. 섬유가 물에 의해 팽윤이 잘 될수록 유연성이 좋아지기 때문에 종이의 물리적 성질이 훨씬 향상된다. 펄프를 물에 현탁시키는 전처리 과정에서 NaOH를 첨가하여 침지과정에서 섬유의 팽윤이 더 잘되게 하기 위함인데, NaOH의 처리량을 증가시킴에 따라 고행 동안 섬유벽의 팽윤이 촉진되어 종이의 강도적 성질이 향상되는 것을 확인할 수 있었다. Pulp fibers must be disintegrated and refined before papermaking. During refining, internal fibrillation of fiber walls are generated, leading to fiber wall swelling. Owing to improved fiber flexibility, strength properties of paper are remarkably improved. This study aimed to explore how NaOH addition to pulp suspension before refining would affect fiber swelling in addition to paper properties. As the addition ratio of NaOH increased, strength properties of paper were greatly improved due to the increase of fiber wall swelling. The extent of fiber wall swelling according to pH was observed by paraffin embedding and physical sectioning. In conclusion, it became evident that higher pH in fiber suspension gave positive contribution to fiber wall swelling during refining.

단기배양을 통한 말초혈액 CD34 양성세포의 체외증폭

박상준,김철희,배광봉,김현수,김종숙,윤환중,조덕연,김삼용 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.1

Background: It is suggested that clinical practice in the areas of bone marrow transplantation and gene therapy might rely on the ex vivo expansion of hematopoietic stem/progenitor cells. However, the condition for ex vivo expansion of hematopoietic progenitor cells is not well established. The authors pursued a series of experiments to define the proper conditions for the expansion of hematopoietic cells in the short-term liquid suspension culture of mobilized peripheral blood CD34+ cells. Methods: 1.0ml cultures were initiated with 9×10^3 PB CD34+ cells, which were isolated from PB mononuclear cells (MNCs) by high-gradient cell sorting, in 12 well plates with the various combinations of hematopoietic growth factors(HGF). The following recombinant human HGFs were used: stem cell factor(SCF) 100ng/ml, granulocyte colony-stimulating factor(G-CSF) 100ng/ml, GM-CSF(granulocyte, macrophage colony-stimulating factor) 100ng/ml, interleukin-1 beta(IL-1B) 1ng/ml, interleukin-3(IL-3) 20ng/ml, interleukin-6 (IL-6) 100ng/ml. At the end of culture, colony-forming cells were evaluated by semisolid clonogenic assay. Results: 1) Using the high-gradient magnetic sorting system, CD34^+ cells were isolated with a yield of 40 3% 2) In 7 day culture of PB CD34^+ cells(9×10^3 cells), nucleated cells expanded mean 10×10^3(range, 9 to 20×10^3) with the addition of SCF alone, 35×10^3(range, 10 to 60×10^3) with SCF plus G-CSF plus GM-CSF, and 130×10^3(range, 40 to 300×10^3) with the combination of SCF, G-CSF, IL-1, IL-3, IL-6, GM-CSF. In 14 day culture, nucleated cells expanded 10×10^3 to 1,860×10^3 with combination of human hematopoietic growth factors. 3) In 10 day culture without medium change of PB CD34^+ cells, CFU-GM numbers expanded 16. 5 fold(range, 7 to 59 fold) with the addition of SCF plus G-CSF plus Il-1 plus IL-3, 31.3 fold(range, 20.5 to 101.1 fold) with the combination of SCF, G-CSF, IL-1, IL-3, GM-CSF. In 14 day culture with or without medium change of PB CD34^+ cells was inferior to 10 day culture for CFU-GM expansion. 4) There was no significant difference for CFU-GM expansion between five growth factors(SCF,G-CSF,IL-1,IL-3,GM-CSF) and six growth factors(five growth factors plus IL-6). Conclusion: The authors could confirm that short-term suspension culture of peripheral blood CD34+ cells could expand hematopoietic progenitor cells. Ten-day culture with medium change of CD34+ cells with the addition of five growth factors, i.e. SCF, G-CSF, IL-1B, IL-3, and GM-CSF, might be the most efficient in this system.

상호상관 함수를 이용한 지중선로 고장점 추정

朴星完,林泳範,鄭州桓,成洛煥,金喆煥,申明徹 成均館大學校 科學技術硏究所 1994 論文集 Vol.45 No.2

This paper is intended as an investigation of fault location for underground line. Over the past few decades a considerable number of studies have been made on protection of underground line. However, these approaches require the interruption of electric power supply from source for fault location estimation. Therefore, we proposed fault location algorithm for underground line protection without interruption of electric power supply. Cross correlation function is used in this algorithm. Also, EMTP data is used to demonstrate the capability of the proposed fault location algorithm.

불응성 자가면역질환에서의 자가조혈모세포이식

민도준,양동원,민창기,김완욱,이상헌,박성환,김동욱,이종욱,조철수,민우성,김범생,김호연,김춘추 대한조혈모세포이식학회 2001 대한조혈모세포이식학회지 Vol.6 No.1

배경: 기존의 치료에 불응하고 예후가 불량한 자가면역질환 환자들에게 최근 고용량 면역억제 및 조혈모 세포이식이 새로운 치료방법으로 대두되고 있다. 저자들은 다발성 경화증(multiple sclerosis, MS) 및 류마티스 관절염(rheumatoid arthritis, RA) 등 2명의 자가면역질환 환자들에서 자가조혈모세포 이식을 시행하였다. 방법: 말초혈액 조혈모세포 가동화를 위하여 cyclophosphamide (4 g/㎡) 및 granulocyte colony stimulating factor (10 g/kg/day)를 투여하였고, CD34+ 세포를 분리·채집 하였다, 이식 전처치로 MS 환자에서 BEAM 및 antihymocyte globulin (ATG) (3.75 mg/kg), RA 환자에서 fludarabine (180 mg/㎡), ATG (10 mg/kg)와 busulfan (8 mg/kg)을 투여하였다. 결과: 호중구 수가 500/㎕ 이상으로 회복되는 기간은 MS 환자에서 9일, RA 환자에서 15일이었다. 혈소판이 20.000/㎕ 이상으로 회복되는 가간은 RA 환자에서 9일 이었고, MS 환자에서는 혈소판 감소증이 발생하지 않았다. 비혈액학적 독성으로 MS 환자에서 WHO 1도의 오심 및 점막염이 관찰되었다. MS 환자는 이식 6개월 후까지 시력감소가 남아있었으나, 이식전에 관찰되던 감각이상 및 운동장애 등의 신경학적 이상 소견은 더 이상 관찰되지 않았다. RA 환자는 이식 1개월 후 관절 증상 및 검사소견의 호전을 보였다. 결론: 불응성 자가면역질환 환자에서 고용량 면역억제 및 조혈모세포이식은 적은 독성으로 높은 치료효과를 기대할수 있으며, 향후 이 시술의 임상적 의의를 규명하기 위하여 전향적이고 장기적인 연구가 필요할 것으로 사료된다. Background: High-dose immunosuppressive therapy followed by autologous hemathpoietic stem cell transplantation (HSCT) has been proposed as a new approach to treat severe, refractory autoimmune diseases. We describe two patients with refractory autoimmune diseases (one multiple sclerosis 〔MS〕and one rheumatoid arthritis〔RA〕) who underwent T-cell-depleted autologous peripheral bleed stem cell transplantation for the first time in Korea. Methods: We mobilized autologous stem cells with cyclophisphamide (4 g/㎡) and granulocyte colony-stimulating factor (10 ㎍/kg/day). Stem cells were enriched ex vivo using CD34-positive immunoselection and reinfused after high-dose chemotherapy with BEAM and antithymocyte globulin (ATG) (3.75 mg/kg) in MS, or fludarabine (180 mg/㎡), ATG (10 mg/kg) and busulfan (8 mg/kg) in RA. Results: The engraftment with an absolute nerutrophil count greater than 500㎕ occurred on day 9 in MS and 15 in RA, respectively. The time to nontransfused platelet count greater than 2.000/㎕ was 9 day in RA. MS patient did not show ant episode of thrombocytopenia. Regimen-related non-hematopoietic toxicity was minimal. For 6 months since HSCT, them patient with MS had been free from previously existed sensory and motor abnormalities except decreased visual acuity. Then patient with RA and only one tender joint and two mildly swollen joints with improvement in laboratory parameters at one month after HSCT. Conclusion: These results underscore the feasibility and potential efficacy of intensive immunosuppression followed by autologous HSCT for treatment of intractable autoimmune diseases. The durability of remission, however, remains to be clarified.

영산강 구하도의 친환경적 활용방안

김철, 김윤환 호남대학교 산업기술연구소 2014 녹색산업연구 Vol.20 No.1

As part of the four-major river restoration project, the 2 old river channels in Yongsan River mainstream were restored. The purpose of the channel restoration was to restore stability, water quality improvement through the maintenance water supply and provide habitats for fish and aquatic insects etc. The survey focused on ecological and environmental functions were carried out, the problems from the survey were analyzed and the eco-friendly measures were proposed in the restored old river channels. The eco-friendly utilization measures of the old river channels are developing the lands inside the channels to core zone for biodiversity, and inducing natural river banks from artificial revetments, and water purification through composition of biological corridors and sluice gate operation. 4대강 살리기 사업의 일환으로 영산강 본류구간에 포함된 구하도 2곳이 복원되었다. 구하도 복원의 목적은 치수안정성 확보, 하천 유지용수 공급을 통한 수질 개선, 어류 및 수서곤충 등의 서식처 제공이다. 복원된 구하도에 대해 생태·환경적 기능을 중점적으로 조사하여 구하도의 문제점 분석과 향후 친환경적 활용방안을 제시하였다. 구하도에 대한 친환경적 활용 방안으로 구하도 수로와 수로내측의 토지를 생물다양성을 위한 핵심존(core zone)으로 개발하고, 하천 수로의 자연하안화를 유도하며, 횡적 연결을 위한 생물이동통로 조성 및 수문조작을 통한 수질정화와 주변 오염원 유입 차단 방안을 제시하였다.

벼 재배방법과 규산질 비료 시용이 생육 및 도복에 미치는 영향

金正鎬,吳成煥,李哲遠,宋凡憲,孫錫龍 忠北大學校 農業科學硏究所 2002 農業科學硏究 Vol.19 No.-

본 시험은 벼 도목을 경감시키기 위한 재배대책을 강구하기 위하여 광안벼를 공시하고, 이앙재배와 담수직파재배에서 규산질 비료를 시용함에 따른 도복경감효과를 조사하였던 바 그 결과를 요약하면 다음과 같다 1 간장은 담순표면직파재배에선 규산시용구가 무처리보다 31cm 감소하여 37%가 단축되었으며, 기계이앙재배에서는 규산시용구가 무처리보다 5cm 감소하여 55% 단축되었다 2 하위절간장은 담수표면직파재배에서 규산시용구가 무처리보다 3.1cm 감소하여 36 9% 단축되었으며, 기계이앙재배에서는 규산시용구가 무처리보다12cm 감소하여 11% 단축되었다 3 좌절중은 담수표면직파에서 규산시용구가 73g이 증가하여 35 2%의 증가율을 보였고, 기계이앙재배에서는 규산시용구가 373g 증가하여 9.6%의 증가율을 보였다 4 수량은 담수표면직파재배에서 규산시용구가 무처리보다 30kg이 많아 64%의 증수효과를 나타내었고, 기계이앙재배에서는 규산시용구가 무처리보다50kg이 많아 9%의 증수효과를 나타내었다 This study was carried out to examine the responses of growth and lodging of rice as affected by both transplanting and direct seeding in waterlogging, which was differently applicated amounts of silicate fertlizers The Kwangan cultivar of Japonica type was used The growths including culm and internode lengths and grain yield were investigated in major growth stages and harvest time The culm length in waterlogging direct seeding was reduced in treatments of silicate fertilizers, about 37%, compared to that in the contro1 and it was reduced to 5.5% in the transplanting cultivation The breaking strength of lower internodes of rice were increased to 35.2% and 96% by applying of silicate fertilizers in the water direct seeding and in the transplanting cultivations, respectively The rice yields were increased with application of silicate fertilizers in both water direct seeding and transplanting cultivations compared to those of the control, about 64% and 90%, respectively.

흉쇄유돌근 피부근육골피판을 이용한 하악골의 재건

김철환,김미숙 乙支病院 1997 乙支醫報 Vol.20 No.1

KCCH cyclotron neutron 및 60Co r-ray에 의한 인체 말초혈액 임파구의 염색체 이상측정

김성호,김태환,정인용,조철구,고경환,류성렬 대한방사선 방어학회 1992 방사선방어학회지 Vol.17 No.1

KCCH cyclotron neutron(30cCy/min) 및 ??Co γ-ray(210cGy/min)를 시험관내의 정상 인체 말초혈액임파구에 조사하여 염색체이상(dicentric 및 centric ring)을 관찰하고 이의 선량-반응관계식을 linear model(Y=K₁D+a), power-law model(Y=K₂Dⁿ), quadratic model(Y=K₃D²) 및 linear-quadratic model(Y=αD+βD²)을 사용하여 구하고 이들 model중 염색체이상의 측정치와 가장 일치하는 관계식을 근거로 하여 γ -ray에 대한 neutron의 relative biological effectiveness(RBE)를 산출하였다. 염색체 이상(dicentric plus centric ring)의 발생분포는 γ-ray의 경우 linear model(P=0.067)을 제외한 power-law model[Y=(5.81±1.96)×10??, P=0.931], quadratic model [Y=(3.91±0.09)×10?D², P=0.972] 및 linear-quadratic model [Y=(6.55±6.83)×10?D+(3.72±0.22)×10?D², P=0.922]에 적합하였다. Neutron의 경우 linear model [Y=(6.12±0.17)×10?³ D-022, P=0.987]에 가장 일치하였고 quadratic model (P<0.005)을 제외한 power-law model[Y=(2.43±0.70)×10?³D+(1.21±0.39)×10?D², P=0.415]에 비교적 적합하였다. 세포당 0.1-1.5개의 염색체이상을 나타내는 neutron의 γ-ray에 대한 RBE는 2.714±0.408이었다. The frequencies of KCCH cyclotron neutron(30cCy/min) or ??Co γ-ray(210cGy/min)-induced asymmetrical interchanges(dicentrics and centric ring) and acentric fragment(deletion) at several doses were measured in the normal human peripheral blood lymphocytes. Chromosome aberrations were scored at the first nitosis after stimulation with phytohemagglutinin. The neutron and γ-ray data were analysed on liner, power-law, quadratic and linear-quadratic model. When the dicentrics and centric rings of γ-ray datas were pooled and fitted to these model, good fits were obtained to power-law [Y=(5.81±1.96)×10??, P=0.931], quadratic [Y=(3.91±0.09)×10?D², P=0.972] 및 linear-quadratic model [Y=(6.55±6.83)×10?D+(3.72±0.22)×10?D², P=0.922] except for linear model(P=0.067). As in the case of neutron data, the best fits was obtained to the linear model [Y=(6.12±0.17)×10?³ D-022, P=0.987] and good fits were obtained to power-law[Y=(5.36±3.02)×10?⁴D??, P=0.601] and linear-quadratic model [Y=(2.43±0.70)×10?³D+(1.21±0.39)×10?D², P=0.415], except for quadratic model (P<0.005). The relative biological effectiveness(RBE) of neutron compared with γ-ray was estimated by best fitting model. In the asymmetrical interchanges range between 0.1 and 1.5 per cell, the REE was found to be 2.714±0.408.